Clavicle Fractures

Similar fractures in adults usually result
from greater violence, are much slower to
unite, and demand more care.
 Classification 3 groups:
– Mid-third, 80%
– Distal or inter-ligamentous, 15%
– Proximal-third 5%
Clavicle Fractures

Among the most common fracture
occurring in children.
 In children usually heal without
problems (the saying goes that if you put
two ends of a fractured clavicle in the
same room [pediatric] they will heal).
Clavicle Fractures

Ideal method of management has not yet
been developed.
 Over 200 methods have been described.
 Most do well with nonoperative
management.
 It may take at least 3 months for adults to
resume heavy activities.
Clavicle Fractures
Clavicle Fractures
Clavicle Fractures
Distal clavicle
fractures more
problematic if
involving the
coracoclavicular
ligaments.
fractur
e
without wts.
with wts.
Clavicle Fractures
Distal clavicle plate
Clavicle Fractures
Displaced
ORIF
Clavicle Fractures
IM
Rod
Acromioclavicular Joint
AC Separations

MOI- direct force
that occurs from a
fall on the point of
the shoulder.
 Major deformity
is the downward
displacement of
the shoulder.
AC Separations

Classification:6 types
of separation.
 Types I-III most
common.
 Grade I - mild forces,
Grade 6 - occurs with
major forces.
AC Separation

Stress X-rays to
differentiate
between Grade I
and Grade 3.
 Gr. III has
upward
displacement 25100% compared
to the normal.
AC Separation
Treatment

Grade I-III is
usually
conservative.
 Sling for comfort.
 Early ROM.
 Grade IV-VI is
usually surgical.

Grade II injuries
can develop DJD.
 Grade III injuries
can be repaired in a
young laborer who
performs overhead
work.
The Elbow
 Little
Leaguer’s elbow
 Osteochondritis dissicans of the
capitellum
 Panner’s disease-osteochondrosis of
the capitellum
Little Leaguer’s Elbow

A term used to describe a number of
overuse conditions about the elbow
associated with repetitive throwing that
affects the skeletally immature elbow
 MOI is valgus extension overload, which
leads to traction stress on the medial
aspect of the elbow, the medial collateral
ligament, and the medial epicondyle
Little Leaguer’s Elbow

Valgus extension overload also results in
compression stresses on the lateral aspect
of the joint, leading to osteochondritis
dissicans of the capitellum, loose bodies,
and radial head overgrowth
 The extension component can cause
repetitive irritation of the olecranon in
the olecranon fossa, which can lead to
impingement & loose bodies
Little Leaguer’s Elbow
Symptoms

Medial pain
 Diminished
throwing
effectiveness
 Decreased
throwing distance
Little Leaguer’s Elbow
Examination

Tenderness
 Swelling over medial epicondyle
 Elbow flexion contraction > 15 degrees
 X-ray- fragmentation and widening of
the epiphyseal lines
Little Leaguer’s Elbow
Little Leaguer’s Elbow
Treatment

Rest ( 4-6 weeks)
 No throwing
 Ice
 NSAID’s
 May strengthen when pain free (>6wk)
Osteochondritris Dissicans
Of The Humeral Capitellum

Represents an island of subchondral bone
and its articular cartilage that begins to
separate from the rest of the humerus
 Symptoms include lateral pain, which is
dull and worsens with motion, which
locks and catches
Osteochondritris Dissicans
Of The Humeral Capitellum

Etiology is unclear
 Repetitive stress most likely cause
 May have genetic predisposition
 Between ages 10-15
 Common in throwers and gymnasts
Osteochondritris Dissicans
Of The Humeral Capitellum
Examination

Radiocapitellar tenderness
 Flexion contracture
 Crepitation
 Effusion
Osteochondritris Dissicans
Of The Humeral Capitellum
Radiology

Crescent shaped
region of sclerotic
subchondral bone
at the humeral
capitellum
 Possible loose
bodies
Osteochondritris Dissicans
Of The Humeral Capitellum
Treatment

If no evidence of separation then rest, ice,
ROM, and analgesics
 Repeat X-ray check for healing
 Surgery if locking, loose bodies,
fragment separation or failure of
conservative management
Panner’s Disease

Osteochondrosis of the humeral
capitellum
 Repetitive valgus stress causes
compressive stress across the
radiocapitellar
 Occurs between 7-12 years of age ( peak
incidence at 9 years)
 May be susceptible at this time due to
limited blood supply
Panner’s Disease
Pathophysiology

Unknown
 May be similar to Legg-Calve`-Perthes
disease
Panner’s Disease
Symptoms

Fairly sudden pain
 Deep and dull achiness
 Worsened with throwing
 No mechanical symptoms (locking or
catching)
Panner’s Disease
Physical exam

Tenderness and swelling over the lateral
elbow
 Mild to moderate flexion contractures
(usually from 5-20 degrees)
Panner’s Disease
Radiology
Fragmentation of
the capitellum,
with alternating
area of sclerosis
and rarefaction
and an irregular
joint surface
Panner’s Disease
Treatment
 Conservative
 Complete rest from throwing until
symptoms subside and ROM is normal
 Repeat X-rays to monitor remodeling
 May return when X-rays and exam is
normal
 Long term disability is rare
The Wrist

Gymnast wrist
 Torus fractures
 Wrist fractures
Gymnast Wrist

Chronic overuse injury occurring at the
physis if skeletally immature gymnasts
 Presents with wrist pain
 Usually due to repetitive hyperextension
and overuse
 Arms are used as weight bearing devices
 Salter-Harris type I injury
Gymnast Wrist
Gymnast Wrist
Gymnast’s wrist frequently show physeal
irregularities and bony sclerosis on X-ray
 If untreated can result in permanent
radial deformity and shortening due to
growth arrest
 Rest relieves symptoms
 Extension splints can prevent recurrence

Gymnast Wrist